Stanford Club of Philadelphia

Please send check made payable to “Philadelphia Stanford Chapter,” and mail with this registration form to: Stanford Club of Philadelphia, P.O. Box 58191, Philadelphia, PA 19102. Questions? Call Mike Borish at 267-243-8676 (cell)

Alternatively, you can register online by logging onto our page on the Stanford Alumni Association website at:

https://alumni.stanford.edu/get/page/groups/overview/?group_id=0038990710

Name: ___________________________________________________________________________________________

Stanford Graduation Year and Major (or name of student(s), if parents): ________________________________________

Address:__________________________________________________________________________________________

City:___________________________________ State: _______ Zip Code: ______________

Phone (Day) :_____________________________________

Phone (Night): _____________________________________

Fax: ____________________________________________

E-mail: __________________________________________

Company Name: __________________________________

Job Title: _______________________________________

Business Address: ________________________________________________________________

City:___________________________________ State: _______ Zip Code: ______________

Spouse/Partner Name: ___________________________________

His/her Degree, Class Year (if Stanford): ________________

_____ Yes, I would like to help plan future Stanford Club of Philadelphia events!

Dues are Free for Young Alumni (Class of 2014-2018) and $15 for an individual or household membership.
Special Rate: A 3-Year individual or household memership is $40.